Help­ing staff who are trau­ma­tized by er­rors

Modern Healthcare - - BEST PRACTICES - By Mau­reen McKin­ney

In 2001, when Ch­eryl Con­nors was just three years into her ca­reer as a nurse, an 18-month-old girl named Josie King died as a re­sult of med­i­cal er­rors on Con­nors’ unit at Johns Hop­kins Hos­pi­tal.

Hos­pi­tal ad­min­is­tra­tors in­structed nurses and physi­cians, who were trau­ma­tized by the lit­tle girl’s death, not to dis­cuss the case. They were left with no sup­port and no way to work through their feel­ings. “Over the next year, I watched a lot of great nurses leave our unit and even leave the pro­fes­sion al­to­gether,” Con­nors said. “The cul­ture on our unit was swirling in the toi­let.”

In the years that fol­lowed, she be­came deeply in­volved in ef­forts to make care safer at the hos­pi­tal, ris­ing to her cur­rent post as pa­tient-safety spe­cial­ist at the hos­pi­tal’s Armstrong In­sti­tute for Pa­tient Safety and Qual­ity. But her ex­pe­ri­ences fol­low­ing Josie’s death stuck with her.

In 2010, she teamed up with Dr. Al­bert Wu, a pro­fes­sor of health pol­icy and man­age­ment at Johns Hop­kins, to find a way to of­fer hos­pi­tal staff needed emo­tional sup­port fol­low­ing ad­verse events. In 2000, Wu wrote about the “sec­ond vic­tim” phe­nom­e­non—a term that refers to the ef­fects that med­i­cal er­rors have on care­givers and staff—in a widely read ar­ti­cle in the jour­nal BMJ.

Af­ter a med­i­cal er­ror, em­ploy­ees may suf­fer from anx­i­ety, shame and de­pres­sion. The symp­toms, if left unchecked, can progress to post-trau­matic stress syn­drome, Wu said. “It’s ev­i­dent that some peo­ple, months and years later, are still try­ing to avoid trig­ger sit­u­a­tions or cer­tain kinds of pa­tients.”

Wu ar­gues that hos­pi­tals need to pro­vide sup­port for stressed em­ploy­ees, not only be­cause it’s the right thing to do, but also be­cause with­out such help, they are more likely to make mis­takes on the job or leave their po­si­tions. There have even been cases of dis­traught care­givers who took their own lives af­ter a med­i­cal er­ror, he said.

An ini­tial meet­ing to gauge in­ter­est in a sup­port pro­gram drew nearly 60 peo­ple, in­clud­ing the hos­pi­tal’s vice pres­i­dent of med­i­cal af­fairs and other top ad­min­is­tra­tors. Wu and Con­nors then as­sem­bled a team and spent sev­eral months dis­cussing goals and de­vel­op­ing train­ing pro­to­cols. They also teamed with the Mary­land Cen­ter for Pa­tient Safety, which pro­vided fund­ing to cre­ate a train­ing cur­ricu­lum and ma­te­ri­als that could be used in other fa­cil­i­ties.

“What we ended up with was a vol­un­teer peer-re­spon­der pro­gram whose sole mis­sion was to pro­vide timely sup­port to staff who had en­coun­tered pa­tient-re­lated events and who could ben­e­fit from help,” Wu said.

In Novem­ber 2011, the team launched a pi­lot of the pro­gram in the pe­di­atrics depart­ment. Eigh­teen vol­un­teers staffed a 24-hour pager and fielded sev­eral calls a month, Con­nors said. Af­ter seven months, they ex­panded the num­ber of peer re­spon­ders to 36 and im­ple­mented the pro­gram, known as RISE—re­silience in stress­ful events— across the en­tire hos­pi­tal. The pro­gram is sep­a­rate from the hos­pi­tal’s root­cause analy­ses and other post-er­ror pa­tient-safety work, fo­cus­ing solely on staff sup­port.

RISE pro­vides peer sup­port, not coun­sel­ing, Con­nors said. Vol­un­teers are trained to of­fer more re­sources if em­ploy­ees need ad­di­tional help af­ter a phone con­ver­sa­tion or in-per­son meet­ing. But in the vast ma­jor­ity of cases, that one in­ter­ac­tion is enough to help them talk through their feel­ings, move for­ward and get back to work, she said.

One big chal­lenge, Wu said, is help­ing staff un­der­stand that they can ask for sup­port. “In healthcare, peo­ple feel like they should be dis­pas­sion­ate and suck it up,” he said. “And when an er­ror oc­curs, they might not feel like they’re de­serv­ing of help.”

Us­ing the Johns Hop­kins cur­ricu­lum, two other hos­pi­tals, Greater Bos­ton Med­i­cal Cen­ter and the Univer­sity of Mary­land Med­i­cal Cen­ter, re­cently launched peer-re­spon­der pro­grams. Greater Bos­ton has re­ceived four calls since its pro­gram be­gan in March, said Carolyn Candiello, the hos­pi­tal’s vice pres­i­dent for qual­ity and safety.

The Mary­land Cen­ter for Pa­tient Safety is in talks with sev­eral other hos­pi­tals that are in­ter­ested in the pro­gram, now known as Car­ing for Care­givers, said Robert Imhoff, the cen­ter’s CEO. Like the pro­gram at Johns Hop­kins, Imhoff ex­pects par­tic­i­pat­ing hos­pi­tals to see even­tual im­prove­ments in em­ployee turnover, em­ployee sat­is­fac­tion and mea­sures of safety cul­ture.

“I saw all of the things we do to foster em­ployee sat­is­fac­tion, like ice cream so­cials and pizza par­ties,” said Imhoff, a for­mer hos­pi­tal ad­min­is­tra­tor. “That’s all well and good. But noth­ing speaks to an em­ployee like a pro­gram that says, ‘We un­der­stand the tremen­dous strain you’re un­der and we are here to sup­port and care for you.’ ”

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.